262237 Safety and Vision in Older Drivers: Does The Evidence Support Current Policy?

Tuesday, October 30, 2012 : 5:30 PM - 5:50 PM

Lori L. Grover, OD , Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
Chuck C. Shih, MHS , Coverage & Analysis Group, Office of Clinical Standards & Quality, Centers for Medicare and Medicaid Services, Baltimore, MD
     
Driving is the preferred means of travel among older adults in the U.S., and older drivers comprise the fastest growing cohort of drivers in the U.S based on number of drivers and miles driven per year. As the percentage of older drivers increases, the use of evidence-based traffic safety policies will become more important. The literature currently does not reflect a consensus on what constitutes the visual criteria and risk factors for improved driver safety in the older driver population, and the assumption that vision impairment (VI) equates to poor driving is not fully supported by the evidence. Through a cost-effectiveness analysis (CEA), we found that the requirement of an annual examination with use of licensure policies that reflect existing state vision standards reduces the number of motor vehicle collisions (MVC) and resulting injury/fatality by approximately 10% when compared to the no annual examination alternative. We also found that requiring an annual eye examination for older driver licensure based on existing visual requirements to reduce MVC is a costly policy alternative. In combination with the mixed body of evidence on MVC risk in the older driver with VI population, current licensure policies that rely primarily on VA status may not target older drivers with the greatest MVC risk. Additional research is needed to identify vision-related licensure policies that most reduce MVC and fatality risk.

Learning Areas:
Public health or related public policy

Learning Objectives:
1. To describe inconsistencies in the literature and lack of continuity between licensure requirements for older drivers throughout the U.S. and emerging evidence related to older drivers, vision and safety. 2. To demonstrate evidence for comprehensive eye examination as a mechanism by which newer research findings can be translated into clinical care. 3. To assess the use of comprehensive eye examination as an intervention option to improve safety and to demonstrate its value through cost-effectiveness analysis (CEA). 4. To identify gaps in the evidence when attempting to bridge the chasm between research and best practices regarding clinical procedures and recommendations for older drivers, associated population risk factors, and state licensure policies related to vision and older drivers.

Keywords: Evidence Based Practice, Public Health Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over twenty years of expertise in the clinical care of patients with vision impairment, and additional training in economic and clinical research methods from my PhD training at the Bloomberg School of Public Health.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Center for Applied Value Analysis Consultant in vision impairment, here for retinitis pignemtosa Consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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